Jonathan Richman at Dose of Digital published his presentation that focused on the future of healthcare. He included the personalized, direct-to-consumer genetic companies, e-health, e-patients and many more emerging topics.
I interviewed about 150 medical leaders just a few years ago for my book The Future of Medicine – Megatrends in Healthcare. Not one mentioned wireless devices as a coming megatrend. How fast the world changes! Nowadays everyone has a cell phone and we rarely stop to think that just two decades ago almost no one had them. We have a laptop or tablet computer that can access information from the web at very high rates of speed; again it is hard to remember when this wasn’t so. And those with smart phones have numerous “apps” – to check traffic conditions, find the nearest Starbucks, or play games. But these and other devices that use wireless technology will lead to major changes in the delivery of health care in the coming years. This is another of those coming medical megatrends.
Read the rest of Wireless devices will dramatically change how medicine is practiced on KevinMD.com.
- Unintended consequences of patient portals (kevinmd.com)
- Invasion of the Body Hackers? Wireless Medical Devices Susceptible to Attacks (tjantunen.com)
- Mobile Security Requires More Than Secure Wireless Devices (aviatnetworks.com)
The world’s attention has recently been focused on the escalation of violence in north and west Africa. Daily reports of deaths and injuries from the region have raised concerns. What is missing from the picture, however, is the fact that many of these countries lack surgical capacity to treat the injured, and this inability to provide surgical care is contributing to a significant rise in the death toll. A recent World Health Organization (WHO) study found that more than 90% of deaths from injuries occur in low- and middle-income countries.1 This is not surprising, considering that the poorest third of the world’s population receives only 3.5% of the surgical operations undertaken worldwide.2 Many hospitals in these countries do not have a reliable supply of clean water, oxygen, electricity and anaesthetics, making it extremely challenging to perform even the most basic surgical operations.3 Despite such a surgical imbalance around the world, surgery is still “the neglected stepchild of global health”.4 No global funding organization focuses specifically on the provision of surgical care, and none of the major donors are willing to support and acknowledge surgery as an imperative part of global public health. This is largely due to the following common misperceptions about surgery that are not grounded in truth. First, many people think that surgical care can only address a very limited part of the global burden of diseases and thus is of low priority. In reality, injuries kill more than five million people worldwide each year, accounting for nearly one out of every ten deaths globally….. …Second, there is a common notion that surgical care is too expensive to be implemented as part of public health interventions. However, surgery can be remarkably cost-effective, even in comparison to non-surgical interventions that are commonly implemented as public health measures. …. ….Lastly, the focus of the global health community on the issue of surgical imbalance has been largely confined to providing short-term relief through medical missions. …
The world’s attention has recently been focused on the escalation of violence in north and west Africa. Daily reports of deaths and injuries from the region have raised concerns. What is missing from the picture, however, is the fact that many of these countries lack surgical capacity to treat the injured, and this inability to provide surgical care is contributing to a significant rise in the death toll. A recent World Health Organization (WHO) study found that more than 90% of deaths from injuries occur in low- and middle-income countries.1 This is not surprising, considering that the poorest third of the world’s population receives only 3.5% of the surgical operations undertaken worldwide.2 Many hospitals in these countries do not have a reliable supply of clean water, oxygen, electricity and anaesthetics, making it extremely challenging to perform even the most basic surgical operations.3
Despite such a surgical imbalance around the world, surgery is still “the neglected stepchild of global health”.4 No global funding organization focuses specifically on the provision of surgical care, and none of the major donors are willing to support and acknowledge surgery as an imperative part of global public health. This is largely due to the following common misperceptions about surgery that are not grounded in truth.
First, many people think that surgical care can only address a very limited part of the global burden of diseases and thus is of low priority. In reality, injuries kill more than five million people worldwide each year, accounting for nearly one out of every ten deaths globally…..
…Second, there is a common notion that surgical care is too expensive to be implemented as part of public health interventions. However, surgery can be remarkably cost-effective, even in comparison to non-surgical interventions that are commonly implemented as public health measures. ….
….Lastly, the focus of the global health community on the issue of surgical imbalance has been largely confined to providing short-term relief through medical missions. …
As a centerpiece of the Patient Protection and Affordable Care Act (ACA) of 2010, the focus on preventive services is a profound shift from a reactive system that primarily responds to acute problems and urgent needs to one that helps foster optimal health and well-being. The ACA addresses preventive services for both men and women of all ages, and women in particular stand to benefit from additional preventive health services. The inclusion of evidence-based screenings, counseling and procedures that address women’s greater need for services over the course of a lifetime may have a profound impact for individuals and the nation as a whole.
Given the magnitude of change, the U.S. Department of Health and Human Services charged the IOM with reviewing what preventive services are important to women’s health and well-being and then recommending which of these should be considered in the development of comprehensive guidelines. The IOM defined preventive health services as measures—including medications, procedures, devices, tests, education and counseling—shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition.
The IOM recommends that women’s preventive services include:
- improved screening for cervical cancer, counseling for sexually transmitted infections, and counseling and screening for HIV;
- a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes;
- services for pregnant women including screening for gestational diabetes and lactation counseling and equipment to help women who choose to breastfeed do so successfully;
- at least one well-woman preventive care visit annually for women to receive comprehensive services; and
- screening and counseling for all women and adolescent girls for interpersonal and domestic violence in a culturally sensitive and supportive manner.
(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability) Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.
An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.
“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”
The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.
“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.
Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:
- improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
- shift resources for the elderly to greater economic and social security and away from more medical care;
- subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
- train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
- shift the emphasis in chronic disease to care rather than cure;
- conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.
- Andrew Reinbach: Health Care Could Kill Us: We Don’t Have to Let It (huffingtonpost.com)
- New at Reason: Ronald Bailey on Health Care Reform (reason.com)
Health services researchers who studied controversial aspects of Medicare spending and quality of patient care received a prestigious award yesterday from the nation’s largest health services research professional association….
…The Article of the Year Award recognized two companion studies by Silber and Kaestner: “Aggressive Treatment Style and Surgical Outcomes,”*** published in the December 2010 issue of the journal Health Services Research, and “Evidence on the Efficacy of Inpatient Spending on Medicare Patients,” ***published the same month in The Milbank Quarterly.
As an indicator of aggressive care, Silber and Kaestner used the Dartmouth Index, a prominent set of measures of inpatient spending on elderly patients. In studying over 5 million Medicare admissions for various surgeries between 2000 and 2005, they found that surgical patients in hospitals with a more aggressive treatment style were less likely to die within 30 days of admission compared to patients in less aggressive hospitals. They also found that this benefit was stable, persisting after the 30-day mark. …
- A promising way to control health costs (money.cnn.com)
- Fewer Medicare Patients Being Hospitalized for Heart Problems (insurance.zocdoc.com)
- Medicare premiums, saving Medicare and more; keep on eye on the real concerns (quinnscommentary.com)
Health Educators, Foundations Announce Competencies And Action Strategies For Interprofessional Education
Two new reports released today by six national health professions associations and three private foundations recommend new competencies for interprofessional education in the health professions, and action strategies to implement them in institutions across the country. By establishing these competencies, the proponents believe our nation’s health care system can be transformed to provide collaborative, high-quality, and cost-effective care to better serve every patient.
- Future of Nursing Campaign Upends Old Ideas on Health Care (rwjfblogs.typepad.com)
- Interprofessionalism (digitalcollaboration.wordpress.com)
HCUP On-line Tutorial Series
From the AHRQ (Agency for Healthcare Research and Quality) press release
HCUP Offers New Online Tutorial Series’ Modules
AHRQ is pleased to announce the release of a new module and an updated re-release of a favorite in the HCUP Online Tutorial Series. These online trainings are designed to provide data users with information about HCUP data and tools, as well as training on technical methods for conducting research using HCUP datasets.
- The all-new Calculating Standard Error tutorial is designed to help users determine the precision of the estimates they produce from the HCUP nationwide databases. Users will learn two methods for calculating standard errors for estimates produced from the HCUP nationwide databases.
- The newly revised HCUP Overview Course is a helpful introduction to HCUP for new users. The original course has been updated to include the latest additions to the HCUP family of databases and tools, including the Nationwide emergency Department Sample.
- HCUP Facts and Figures: Statistics on Hospital-based Care in the United States (jflahiff.wordpress.com)
- New Analysis Illustrates the Hidden Burden of Atrial Fibrillation on Healthcare Spending and Resources in Each State (prnewswire.com)
- AHRQ News And Numbers: Medication Side Effects, Injuries, Up Dramatically (jflahiff.wordpress.com)
- New Tab: Tutorials (tinysewingempire.wordpress.com)
From the Nation’s Health ( April 2011, vol. 41 no. 3 , pp 1-20)
During a recent office visit, Robert Wolverton, MD, provided a young woman with emergency contraceptives, helped her restart regular birth control, evaluated a rash she was concerned about and investigated the cause of her ear pain.
Some doctors discourage patients from discussing multiple problems during one appointment, Wolverton said, but that recent patient was like many he sees at the Teen Wellness Center at T.C. Williams High School in Alexandria, Va. She had health concerns and she wanted to handle them quickly and confidentially….
…Nationwide, the number of school-based health centers is climbing, according to Linda Juszczak, DNSc, MPH, MS, CPNP, executive director of the National Assembly on School-Based Health Care. The City of Alexandria has had a wellness center for adolescents for more than a decade, but the previous center was located in a trailer off school property that students had a hard time accessing, Wolverton said….
The new center is one of more than 1,900 school-based health centers nationally operating in 48 states and territories. Such centers provide access to primary health care, mental health services, immunizations, sexually transmitted disease testing and a host of other services to about 2 million children and youth, regardless of ability to pay.
The centers are an attractive option for young patients seeking health care, as no patient will be turned away because she or he is not able to pay, said Terri Wright, MPH, director of APHA’s Center for School, Health and Education. In some places, school-based health centers open their doors to adults during non-school hours and bill third-party payers for their care as a way to make ends meet, Wright said.
The growth of school-based health centers such as the one in Alexandria may speed up in the near future, thanks to the health reform law passed last year.
- Columbus schools a center for students’ health care (dispatch.com)
- Oakland, L.A. schools to add health centers (sfgate.com)
- Health care part of Columbus schools’ services (dispatch.com)
ScienceDaily (Mar. 21, 2011) — Patients who’ve been hurt in car or bike crashes, been shot or stabbed, or suffered other injuries are more likely to live if they arrive at the hospital on the weekend than during the week, according to new University of Pennsylvania School of Medicine research published in the March 21 issue of Archives of Surgery. The findings, which also showed that trauma patients who present to the hospital on weeknights are no more likely to die than those who presented during the day, contrast with previous studies showing a so-called “weekend effect” in which patients with emergent illnesses such as heart attacks and strokes fare worse when they’re hospitalized at night or on weekends.
The authors say the trauma system’s unique organization and staffing appears to serve as a built-in protection for these critically injured patients, and may provide a roadmap for ongoing efforts to restructure and better coordinate U.S. emergency care, which needs to provide optimal care day or night.
“Whether patients have an emergent illness or a severe injury, the common denominator is time. Patients must rely on the system to quickly get them to the place that’s best prepared to save their lives,” says lead author Brendan G. Carr, MD, MS, an assistant professor in the departments of Emergency Medicine and Biostatistics and Epidemiology. “Trauma systems have been designed to maximize rapid access to trauma care, and our results show that the system also offers special protection for patients injured during periods that are known to be connected to worse outcomes among patients with time-sensitive illnesses.”…
- Rehabilitation for Brain Trauma Patients (brighthub.com)
- Medical Consequences of Testicular Trauma in Childhood (brighthub.com)
- Vulnerable Patients May Lack Access to Trauma Care (nlm.nih.gov)
- Trauma Patients Fare Poorly After Hospital Discharge (webmd.com)
- Trauma patients have higher rate of death for several years following injury (physorg.com)
- Risk of hospital patient mortality increases with nurse staffing shortfalls, study finds(ScienceDaily)
- Military Funds Brain Injury Study: Immediate Nutrition Is Key (April 2011)
Excerpt: Due to a high level of brain injury in the field, the United States Military commissioned the Institute of Medicine (IOM) to look into the best way to immediately treat traumatic brain injuries. The institute found that a quick infusion of calories, proteins and vitamins should now be a part of standard care in the military. This research will cross over into the public sector as well…
From the March 18 2011 DISASTR-OUTREACH-LIB **posting
Disaster Medicine and Public Health Preparedness
The March 2011 issue of this journal includes an article titled,
“Supporting Evidence-based Health Care in Crises: What Information Do Humanitarian Organizations Need?” ***as well as a selection of open access articles relevant to the Japan earthquake. [Submitted by Anna Gieschen]
Supporting Evidence-based Health Care in Crises
What Information Do Humanitarian Organizations Need?
Tari Turner, PhD, Sally Green, PhD and Claire Harris, MBBSAuthor Affiliations: Dr Turner and Dr Green are with the Australasian Cochrane Centre, Monash University, Victoria, Australia; and Dr Harris is with the Centre for Clinical Effectiveness, Southern Health, Victoria, Australia.
In crisis situations, there is an enormous burden of disease and very limited resources. To achieve the best possible health outcomes in these situations and ensure that scarce resources are not wasted, knowledge from health research needs to be translated into practice. We investigated what information from health research was needed by humanitarian aid workers in crisis settings and how it could be best provided. Semistructured interviews were conducted by telephone with 19 humanitarian aid workers from a range of organizations around the world and the results analyzed thematically. Participants identified a clear and currently unmet need for access to high-quality health research to support evidence-based practice in crisis situations. They emphasized that research into delivery of health care was potentially morevaluable than research into the effectiveness of particular clinical interventions and highlighted the importance of includingcontextual information to enable the relevance of the research to be assessed. They suggested that providers of health research information and humanitarian aid organizations work together to develop these resources. [editor Flahiff’s emphasis]
**DISASTR-OUTREACH-LIB is a discussion group for librarians, information specialists and othersinterested in disaster information outreach to their communities and responding to information needs for all-hazards preparedness, response and recovery.
The DISASTR-OUTREACH-LIB archives are available at
- U.S. Unprepared for Major Radiation Emergency: Survey (jflahiff.wordpress.com)
- Emergency mental health lessons learned from Continental Flight 3407 disaster (scienceblog.com)
- Disaster Preparedness: Is Your Family Ready? (abcnews.go.com)
- Japan earthquake – disaster relief information sources (openmedicine.ca)
- Japan’s Disaster and the Limits of Self-Sufficiency (scienceblogs.com)
- Health care needs public acceptance of evidence based medicine (kevinmd.com)
ress Release Date: February 28, 2011
Improvements in health care quality continue to progress at a slow rate—about 2.3 percent a year; however, disparities based on race and ethnicity, socioeconomic status and other factors persist at unacceptably high levels, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report issued today by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).The reports, which are mandated by Congress, show trends by measuring health care quality for the Nation using a group of credible core measures. The data are based on more than 200 health care measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.
“All Americans should have access to high-quality, appropriate and safe health care that helps them achieve the best possible health, and these reports show that we are making very slow progress toward that goal,” said AHRQ Director Carolyn M. Clancy, M.D. “We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement.”
Gains in health care quality were seen in a number of areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42 percent in 2005 to 81 percent in 2008.
Other very modest gains were seen in rates of screening for preventive services and child and adult immunization; however, measures of lifestyle modifications such as preventing or reducing obesity, smoking cessation and substance abuse saw no improvement.
The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians and Alaska Natives received worse care than whites for about 40 percent of core measures. Asians received worse care than whites for about 20 percent of core measures. And Hispanics received worse care than whites for about 60 percent of core measures. Poor people received worse care than high-income people for about 80 percent of core measures.
Of the 22 measures of access to health care services tracked in the reports, about 60 percent did not show improvement, and 40 percent worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3 percent of people saying they were unable to get or had to delay getting prescription medications to 60 percent of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.
Each year since 2003, AHRQ has reported on the progress and opportunities for improving health care quality and reducing health care disparities. The National Healthcare Quality Report focuses on national trends in the quality of health care provided to the American people, while the National Healthcare Disparities Report focuses on prevailing disparities in health care delivery as it relates to racial and socioeconomic factors in priority populations.
For more information, please contact AHRQ Public Affairs: (301) 427-1892 or (301) 427-1855.
Use Twitter to get AHRQ news updates: http://www.twitter.com/ahrqnews/
(Elsevier) Elsevier/MEDai, a leading provider of advanced clinical analytic health-care solutions, announced today the launch of the latest version of Pinpoint Review, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.
ORLANDO, FL – 14 February, 2011 – Elsevier / MEDai, a leading provider of advanced clinical analytic healthcare solutions, announced today the launch of the latest version of Pinpoint Review®, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.
“Hospitals are facing an enormous amount of pressure to provide better, safer care with fewer complications while managing costs,” said Swati Abbott, President of Elsevier / MEDai. “Elsevier / MEDai has enhanced its predictive analytics product to continuously give hospitals and clinicians the most up-to-date tools they need to lower mortality rates and healthcare costs, provide a higher quality of care, increase patient safety and maintain regulatory compliance.”
Pinpoint Review generates predictions for acute-care patients, focusing on the likelihood of a patient developing a complication, contracting a healthcare-acquired infection or being readmitted within 30 days of discharge, while patients are still in the hospital and there is time to adjust care to avoid a negative outcome.
With the expansion of Pinpoint Review’s new predictions, care givers are able to enhance their efforts in proactive care management. Pinpoint Review unlocks the power of clinical and administrative hospital data by utilizing predictive technologies to turn data into actionable information. Empowering today’s hospitals with the ability to predict whether or not a patient will be admitted to the ICU or higher intensity care unit, a predicted length of hospital stay or patient expiration goes a long way in driving down the cost of care and brings a proactive approach to quality improvement.
Pinpoint Review addresses the increasing pressure on hospitals from entities such as the Agency for Healthcare Research and Quality and the Joint Commission on Accreditation of Healthcare Organizations to deliver a higher quality of care and fewer medical errors. Pinpoint Review alerts care providers to patients at risk for developing several of the conditions that the Centers for Medicare and Medicaid Services (CMS) no longer reimburse.
From the January 31, 2011 Reuters news item by Genevra Pittman
NEW YORK (Reuters Health) — Hospitals that spend more money treating patients with acute illnesses may be better at keeping those patients alive, suggests a new study.
The finding is in line with recent research, but it challenges an assumption held by many policymakers that hospitals can be forced to spend less without significant consequences for patient health.
“The traditional literature on spending is that quality isn’t higher (in hospitals that spend more),” said Mary Beth Landrum, who studies health care policy at Harvard Medical School and did not participate in the research. But, “when you start looking at specific groups of patients, you may actually find that there is some benefit for some of the increased spending,” she told Reuters Health.
The current study included people treated for heart attack, heart failure, stroke, hip fracture, pneumonia and serious stomach bleeding. Researchers led by Dr. John Romley of the University of Southern California looked at records for more than 2.5 million of these patients admitted to California hospitals during the years 1999 through 2008.
Romley’s team calculated how likely the patients were to survive their hospital stay, then compared those numbers to how much money the hospitals typically spent to treat the conditions in question.
For each of the six conditions, they found the highest-spending hospitals spent more than three times as much as the lowest-spenders.
Those hospitals ranking in the bottom-fifth for expenditures on heart failure and hip fracture, for instance, averaged $5,100 caring for a heart failure patient and $8,000 treating a hip fracture. The top-fifth-spending hospitals for the same conditions averaged $19,000 on a heart failure patient and $29,000 on one with hip fracture.
For each of the conditions examined higher spending was also linked to higher patient survival.
Patients treated at the highest-spending hospitals for heart failure, for example, had a 25 percent smaller chance of dying while they were there than patients treated at lowest-spending hospitals.
During the second half of the study (2004 to 2008) the mortality differences seen with high or low spending on hip fracture patients were extremely small, but overall the researchers say the numbers show money does seem to make a difference in survival.
If all patients in the study who were treated at the lowest-spending hospitals had instead been treated at the highest-spending facilities, the authors calculated that about 18,000 fewer people would have died during the first half of the study, and 14,000 fewer during the second half.
What exactly high-spending hospitals are doing to save lives is not completely clear.
Previous research suggests hospitals that spend more money don’t have fewer complications during care — they may just be more prepared to notice and address complications quickly, said Dr. Amber Barnato, who studies end-of-life care at the University of Pittsburgh and was not involved in the current study.
“There must be something about paying close attention, which might mean more staff, more eyes on the patients,” Barnato told Reuters Health. In addition, she said, “there might be a greater willingness to do intensive things to rescue someone, like put them on a breathing machine (or) put them in the (intensive care unit).”
The findings, published in the Annals of Internal Medicine,*** are in line with a few recent studies, including one showing that hospitals where heart failure is treated frequently give better care but also spend more money per patient than hospitals that treat the condition less frequently.
Together such studies challenge the assumption that much of hospital spending is inefficient and that hospitals could perform just as well with smaller budgets, researchers say.
That debate has been an important part of the controversy surrounding new health care reform legislation, which will cut back Medicare spending on hospitals, Romley noted.
“If the results are real … that would suggest these reductions across the board in hospital spending might lead to worse outcomes for some patients,” Romley told Reuters Health. That doesn’t mean cuts wouldn’t still be cost-effective, if money elsewhere could better improve public health. But, he added, “it is important to understand the trade-offs.”
The new findings need to become part of the national debate on how best to allocate money to protect the health of the general population — but they don’t change the fact that health care funding isn’t in unlimited supply, Barnato said.
Even if patients with serious illnesses such as the ones examined in the current study do make it out of the hospital alive, many die within a year, and some of the money used on end-of-life care might save more lives if it was used to address preventable childhood diseases or obesity, for example, she said.
“A hospital that spends more money can have slightly better quality or safety,” Barnato explained, “and that spending might still not result in better population health.”
***For suggestions on how to get this article for free or at low cost, click here
Finding Low Cost Mental Health Care (written for teens)
In addition to school counselors, these options were presented, as well as how to get help in a crisis, how to get financial assistance, what to do if you don’t want your parents to know you are seeking mental health help, and prescription assistance
- Local mental health centers and clinics. These groups are funded by federal and state governments so they charge less than you might pay a private therapist. Search online for “mental health services” and the name of the county or city where you live. Or, go to the website for the National Association of Free Clinics. The U.S. Department of Health and Human Services’Health Resources and Services Administration also provides a list of federally funded clinics by state.
(Note: By clicking either of these links, you will be leaving the TeensHealth site.)
One thing to keep in mind: Not every mental health clinic will fit your needs. Some might not work with people your age. For example, a clinic might specialize in veterans or kids with developmental disabilities. It’s still worth a call, though. Even if a clinic can’t help you, the people who work there might recommend someone who can.
- Hospitals. Call your local hospitals and ask what kinds of mental health services they offer — and at what price. Teaching hospitals, where doctors are trained, often provide low- or no-cost services.
- Colleges and universities. If a college in your area offers graduate degrees in psychology or social work, the students might run free or low-cost clinics as part of their training.
- On-campus health services. If you’re in college or about to start, find out what kind of counseling and therapy your school offers and at what cost. Ask if they offer financial assistance for students.
- Employee Assistance Programs (EAPs). These free programs provide professional therapists to evaluate people for mental health conditions and offer short-term counseling. Not everyone has access to this benefit: EAPs are run through workplaces, so you (or your parents) need to work for an employer that offers this type of program.
- Private therapists. Ask trusted friends and adults who they’d recommend, then call to see if they offer a “sliding fee scale” (this means they charge based on how much you can afford to pay). Some psychologists even offer certain services for free, if necessary. You can find a therapist in your area by going to the website for your state’s psychological association or to the site for the American Psychological Association (APA). To qualify for low-cost services, you may need to prove financial need. If you still live at home, that could mean getting parents or guardians involved in filling out paperwork. But your therapist will keep everything confidential.
Additional Mental Health resources, especially for teens
- Teen Health – Your Mind has links to many articles written for teens in areas as Parents, Feeling Sad, Mental Health, Feelings and Emotions, Body Image, Families, Friends, and Dealing with Problems
- Teen Mental Health (MedlinePlus) has links to Web pages about treatment, specific conditions (as cutting), patient handouts, and more
From hotel-style room service to massage therapy to magnificent views, hospitals are increasingly touting their luxury services in a bid to gain market share, especially those in competitive urban markets. An important new article, published today in the New England Journal of Medicine, raises crucial questions about the role of amenities in hospital care, explaining that how we decide to value the patient experience can have a significant effect on health care costs. “Though amenities have long been relevant to hospital competition, they seem to have increased in importance — perhaps because patients now have more say in selecting hospitals,” explained corresponding author John Romley, an economist with the Schaeffer Center for Health Policy and Economics at USC and research assistant professor in the USC School of Policy, Planning, and Development. Empirical evidence and surveys seem to confirm that patients increasingly value the nonclinical experience more than measures of clinical quality, such as a hospital’s risk-adjusted mortality rate. In a “Perspectives” piece in New England Journal of Medicine, the authors cite their own research showing that Medicare patients often do not choose the hospital nearest to them. They are willing to travel — and not necessarily for better clinical care, even in cases involving heart attack, where risk of death should be an overriding concern. Rather, the proportion of patients who received care at a given hospital was strongly correlated to the quality of amenities. Improved perks also have a significant effect on hospital volume. “On a societal level, the value of amenities is important because our health care system currently pays for them,” explained lead author Dana Goldman, director of the Schaeffer Center at USC and Norman Topping Chair in Medicine and Public Policy at the USC School of Policy, Planning, and Development. “A hospital seeking to strengthen its financial position might view investment in amenities as a sound strategy to attract patients. The question is, however, what effect such a strategy might have on patients’ outcomes as well as on overall health care costs.” The researchers note that if amenities create environments that patients and providers prefer, the result may be better treatment and improved health outcomes. Accounting for patient experience can either help us determine whether amenities are necessary to better performance or tell us if hospitals should shift their focus entirely to clinical quality instead. “As health care reform moves forward, we need to decide whether amenities are a valuable part of the hospital experience,” Romley said. “If they are, policymakers should include them in the measures for overall quality, prices and productivity.” ### Mary Vaiana at RAND was also an author of this paper. Goldman, et al. The Emerging Importance of Patient Amenities in Hospital Care. New England Journal of Medicine. December 2, 2010.
Whether it’s a car repair that didn’t fix the problem or a bad meal in a restaurant, many of us don’t hesitate to complain. Making our voices heard when something isn’t right is the first step in getting it corrected. But when we’re sick or need health care services, it’s hard to know where to direct a complaint. And it can be difficult to question people who may know more than we do, especially when we aren’t feeling well.
These reasons are valid, but they shouldn’t be obstacles. As a physician, I’m encouraged that consumers are becoming more comfortable asking their medical team questions. I hope this continues.
Hospitals and health groups have tried to make it easier for patients to raise concerns or complaints. But it’s still not easy to do. Health services are delivered in many different settings and are often not coordinated from one place to the next. So it’s up to the patient or his or her family to identify where to make a complaint and to follow through and report the problem.
A very helpful Government resource, called the Beneficiary Ombudsman, is available for people covered by Medicare or Medicare health plans. This Web site can serve as your first stop to learn how these and other Government programs work and how to file a complaint or an appeal.
People who are covered by private insurance should review the information they get when they enroll to find out who to contact when they have complaints.
Here are some resources for complaints or concerns that arise:
While you are in the hospital: If possible, first bring your complaints to your doctor and nurses. Be as specific as you can and ask how your complaint can be resolved. You can also ask to speak to a hospital social worker who can help solve problems and identify resources. Social workers also organize services and paperwork when patients leave the hospital.
If you are covered by Medicare, you can file a complaint about your care with your State’s Quality Improvement Organization (QIO). These groups act on behalf of Medicare to address complaints about care provided to people covered by Medicare.
Typical complaints QIOs handle are getting the wrong medication, having the wrong surgery, or receiving inadequate treatment. You can also find your QIO by calling 1-800-MEDICARE.
If you get an infection while you are in the hospital or have problems getting the right medication, you can file a complaint with the Joint Commission. This group certifies many U.S. hospitals’ safety and security practices and looks into complaints about patients’ rights. It does not oversee medical care or how the hospital may bill you.
To find out what other patients had to say about their recent hospital stays, visit the Hospital Compare Web site. You’ll find answers from patients about how well doctors and nurses communicated, how well patients’ pain was controlled, and how patients rated their hospital.
If you are discharged before you’re ready: This is a big concern for many patients because insurers balk at long hospital stays. Talk to the hospital discharge planner (often a social worker) if you don’t think you’re medically ready to leave the hospital. The discharge planner will take your concerns to the doctor who makes this decision.
If you are covered by Medicare or by a Medicare managed care plan, you can file an appeal about a discharge while you are still in the hospital. You should get a form from the hospital titled “An Important Message from Medicare,” which explains how to appeal a hospital discharge decision. Appeals are free and generally resolved in 2 to 3 days. The hospital cannot discharge you until the appeal is completed.
When you get your hospital bill: First, ask your doctor or the hospital’s billing department to explain the charges. Find out how the hospital handles complaints about bills, and make your case. If you still have questions, you should contact the Medicare carrier that handles billing issues for your Medicare program.
You can also call 1-800-MEDICARE about billing questions. Make sure you have the date of service, total charge in question, and the name of your doctor and hospital.
Even with this information, it’s not easy to be as assertive in a health care setting as it is in an auto repair shop or restaurant. But it’s a smart move that can help you get the quality care that you deserve.
I’m Dr. Carolyn Clancy and that’s my advice on how to navigate the health care system.
Agency for Healthcare Research and Quality
Questions Are the Answer: Get More Involved With Your Health Care
American Health Quality Association
Quality Improvement Organization (QIO) Locator
The Joint Commission
Report a Complaint about a Health Care Organization
Department of Health and Human Services
Beneficiary Ombudsman: Inquiries and Complaints
Department of Health and Human Services
Hospital Compare—A Quality Tool Provided by Medicare
Department of Health and Human Services
Medicare Appeals and Grievances
Department of Health and Human Services
Current as of March 2009